Prevalence of Orthostatic Hypotension and Relationship With Drug Use Amongst Older Patients

Pepersack, Thierry; Gilles, Christian; Petrovic, Mirko; Spinewine, Anne; Baeyens, Hilde; Beyer, Ingo; Boland, Benoît; Dalleur, Olivia; Lepeleire, Jan De; Even-Adin, Danièle; Nes, Marie-Claire Van; Samalea-Suarez, Audrey; Somers, Annemie

doi:10.2143/acb.3215

Cited by 28 publications

(16 citation statements)

References 66 publications

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“…The acute administration of antihypertensive medications can produce significant hypotension in older adults which may threaten cerebral perfusion thereby causing dizziness, syncope, and falls (Pepersack et al, 2013; Rutan et al, 1992; Shannon et al, 1986; Slavachevsky et al, 2000). This mechanism may explain recent findings indicating from hundreds of thousands of Canadian older adults indicating that initiation of antihypertensive treatment significantly increases risk of both falls (Incident Risk Ratio [IRR] = 1.69] and hip fractures [IRR = 1.43] within the first 45 days of treatment (Butt et al, 2012; Butt et al, 2013).…”

Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

“…To our knowledge these are the strongest data indicating the risks of early antihypertensive treatment on falls and fractures in the elderly. However, these negative effects on cerebral perfusion are thought to be short-term and wane after prolonged drug administration (Pepersack et al, 2013; Rutan et al, 1992; Shannon et al, 1986; Slavachevsky et al, 2000). As a result, Lai and Laio reiterated the importance of a key principle for medication prescription for older adults: “start low and go slow” (Lai and Liao, 2013).…”

Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

See 1 more Smart Citation

Hypertension and aging

Buford

2016

Ageing Research Reviews

422

289

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Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms – including inflammation, oxidative stress, and endothelial dysfunction – are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

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Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

422

289

View full text Add to dashboard Cite

show abstract

“…The existing evidence concerning relationship between OH and geriatric conditions or drug use in older adults (inpatients) is scarce. 1 …”

Section: Introductionmentioning

confidence: 99%

Orthostatic hypotension and associated conditions in geriatric inpatients

Jodaïtis

Vaillant

Snacken

et al. 2015

Acta Clinica Belgica

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Screening of orthostatic hypotension (OH) was performed in 285 patients aged 75 years. Current drugs, reasons for admission, geriatric syndromes, and confounding medical conditions were collected. Patients with OH (n = 116, 41%) as compared to those without OH (n = 169) more frequently (P < 0.01) presented falls in the last 6 months (62 vs. 40%, P < 0.001), a fall as the reason for the current admission (49 vs. 26%, P < 0.001), feeling of fainting (20 vs. 6%, P = 0.002), syncope (29 vs. 4%, P < 0.001) or functional decline (71 vs. 47%, P = 0.012). No difference was observed between the two groups in terms of age (85 ± 5 vs. 84 ± 4 years), gender (59 vs. 50% female), common geriatric conditions (e.g. malnutrition 46 vs. 58%, dementia 22 vs. 26%), comorbidity or confounding conditions (dehydration 28 vs. 30%, sepsis 2 vs. 6%). No difference was detected in the use of drugs with psychotropic cardiovascular or diuretic effect, or in their associations. Orthostatic hypotension is frequent upon hospital admission and should be screened, particularly in geriatric fallers. This absence of relation between OH and drugs use suggests that non-pharmacological interventions should be first attempted in older inpatients with OH before deciding to reduce or withdraw useful drugs.

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“…Thus it is possible to detect orthostatic hypotension, defined as a decline of at least 20 mmHg of SBP and/or 10 mmHg of DBP in standing vs. the sitting position [13]. The detection of this condition is particularly important in older subjects, as it is particularly frequent and has been associated with falls, cardiovascular events, and total mortality [5,6]. Therefore the choice of antihypertensive treatment should be based on orthostatic together with sitting BP values.…”

Section: Peculiar Aspects Of Bp Measurementmentioning

confidence: 99%

“…Orthostatic hypotension in particular seems to be associated both with antihypertensive treatment and with an increased fall risk [5] and was also found to increase the risk for mortality and cardiovascular events in a recent meta-analysis [6]. Of notice, in a large population-based study, older subjects showed a significant increase in hospitalizations for hip fracture over the 45 days after initiation of antihypertensive drug treatment [7].…”

Section: Introductionmentioning

confidence: 99%